title: Ultrasound and early tape mobilization--a practical solution for treating postoperative voiding dysfunction.
abstract: OBJECTIVE
  This study assessed the effectiveness of ultrasound in determining tape distance to urethra and the impact of early tape mobilization on outcomes in women with postoperative voiding dysfunction resulting from a too tightly positioned tension-free vaginal tape (TVT).
  
  
  METHODS
  A prospective observational study was conducted with women experiencing voiding dysfunction caused by too tightly positioned tapes. Ultrasound was used to identify the cause of the dysfunction and measure the distance between tape and longitudinal smooth muscle layer (LSM) of the urethra. If the tape was too close to the LSM (<3 mm) and the residual volume was >100 ml, it was mobilized under local/analgosedation shortly after the initial TVT procedure.
  
  
  RESULTS
  Seventy-one postoperative TVT mobilization procedures were conducted on 61 women, which was 4.1% (61/1501) of all suburethral tape procedures performed. Early tape mobilization restored normal micturition in 59 (96.7%) of the women at the time of discharge. Significant differences were found in residual volumes (P < 0.001) and tape-LSM distances (P < 0.001) pre- and post-mobilization. At 6-month follow-up visits, 58 (95.1%) women were cured of SUI, three were incontinent, and no additional voiding dysfunction occurred.
  
  
  CONCLUSIONS
  Immediate postoperative ultrasound can reliably detect too tightly positioned tapes that can be promptly treated with tape mobilization, a short and safe procedure that does not compromise the outcome of the original procedure.
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Rautenberg
authors.forename: Jacek
authors.initials: J
authors.lastname: Kociszewski
authors.forename: JoEllen
authors.initials: J
authors.lastname: Welter
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kuszka
authors.forename: Jakob
authors.initials: J
authors.lastname: Eberhard
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011184:Postoperative Period; D011446:Prospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics
keywords: obstructive voiding dysfunction; pelvic floor ultrasound; stress urinary incontinence; surgical complications; tape mobilization; urinary retention